Breast reconstruction after lumpectomy-radiation and quadrantectomy-radiation

Abstract

Breast conservation performed either as a lumpectomy or quadrantectomy followed by radiotherapy effectively manages early breast cancer but can be associated with unfavorable cosmetic outcomes in approximately 10% of patients. Surgical factors relating to the technique of the primary procedure, along with the intensity and duration of the radiotherapy, are known to influence breast cosmesis. Evaluation of unsatisfactory aesthetic results shows a characteristic radiated lumpectomy or quadrantectomy deformity comprised of some combination of nipple dislocation, cutaneous deficiency, and parenchymal loss. Recent efforts to correct these defects have used autogenous tissues such as the latissimus dorsi or rectus abdominis myocutaneous flap. In particular, the latissimus dorsi flap is preferred because of the minimal donor site morbidity and low incidence of serious complications. In this population of patients with a continuing need for cancer surveillance, latissimus dorsi myocutaneous flaps do not interfere with either the mammographic or physical examination of residual breast tissue. However, they do provide aesthetic improvement for radiated partial mastectomy deformities. Certain technical modifications described in this section are necessary for optimal aesthetic restoration of breast contour. Additional benefits have included preservation of sensate native skin flaps and enhanced symmetry with the contralateral breast. Although the rectus flap is an acceptable alternative, especially if a recurrence of breast cancer develops, the latissimus dorsi flap has emerged as the preferred choice.